The blog of Environmental and Public health news, opinion and articles in Nigeria.
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Tuesday, May 3, 2011

How not roll back malaria

By Sani Garba Mohammed

World malaria Day is with us today. The theme of this year’s celebration is: ``Achieving Progress and Impact’’, while the slogan is the ``Play Your Part’’. Whatever the theme is, it is obvious that rolling back malaria is going nowhere as the emphasis is on drugs and nets, than environmental health management.The minister of health, on commemorating the day, did not say anything on the later which had great effect on the vector causing organism in our environment, he talks mainly on artemisin drugs and nets, which children will be use as change agent. Read my ealier postage on the report, as reported by Daily Triumph, May 04, 2011.I here by reproduced an article I wrote in May 2006, in commemorating world malaria day then, which is still relevant, as the issues I raised had not been address by our government. I hope our governments at all level will pay more emphasis on preventive health services through environmental health services, so that malaria burden be reduced in the short term, and eradicated in the long term.

Malaria , the ‘King of Diseases’, is re-emerging as world’s number one killer infection [Pharmanews, January, 2009] and it has been a big threat to the African continent and other parts of the world. It kills millions of people ranging from pregnant women, children and others to the extent now it is regarded as Weapon of Mass Destructions [WMD] in Africa, for according to World Health Organization [WHO] it kills in every 30 second.

It is reported that malaria [notified cases] in 2000 in Nigeria was about 2.4million. The disease, account for 25% of infant mortality and 30% of childhood mortality in Nigeria, [Guardian April 25, 2008].

Because of its importance, African leaders had to meet in Abuja in April 2000 in what was called 'African summit on Roll back Malaria' to discuss on how to end the disease, and even at world level, 193 nations met in May 2007 and considered latest report on Malaria, and agreed to create a special day [25th April each year] for the disease, which, despite it consequences, little is known and done about it.

Malaria is a preventable disease, its vector causing agent lie wholly in our environment, places like stagnant water, abandoned properties, weeds and any other places that has poor hygiene. Instead of our government to major their focus towards environmental health management and sanitation, they shift their focus on curative aspect of the disease precisely provision of drugs and supply of insecticide treated nets. More and more money is being committed toward the control and eradication of malaria, yet with little or no impact.

Malaria is a parasitic disease caused by infected anopheles mosquitoes that breeds in our environment, and it is a serious and fatal disease if not promptly treated. Four kinds of malaria parasites can infect humans: plasmodium falciparum, plasmodium vivax, plasmodium ovale and plasmodium malariae. According to the report of Dr Philip Agomo, based on the study conducted in the six geopolitical zones of the country, it was found that malaria account for average 11% maternal deaths, and the prevalence rate among pregnant women was 48.2%. The study also put the prevalence rate as follows: North-west 46.6%, North-east 64.5%, North-central 56.4%, South-west 46% South-east 31% and South-south 44% [Pharmanews January 2008].

Malaria impedes human development, as its cause underdevelopment of nations, by making them to lose billions of dollars from cost of treatment, absenteeism from schools, farms and work.

Malaria probably competes with poverty, irrational planning, corruption, and criminal mismanagement by local, state and federal governments in destroying the economy. Equally, it is implicated in the reduction of human work capacity and productivity of all sectors of the economy, [Pharmanews January 2008].

Besides these, the end results of malaria infection are too devastating to be taken for granted, which include anaemia, kidney failure, brain damage or simply cerebral malaria, malnutrition, metabolic abnormalities, etc.

As it is known, malaria is an environmentally based disease, which can be prevented and control by integrating fully environmental health management approach into our health services, our leaders seems to be blinded by supporting drugs and treated nets. As such, "No amount of insecticides-treated nets' said Fidel Agu "without a clean AND HEALTHY environment can lead to a meaningful and sustainable war againstmalaria in Nigeria. Any attempt therefore to eradicate malaria must start with our environment" [Leadership March 2, 2008, emphasis mine].

The promotion of drugs [Artemisinin based combination therapy] and insecticides nets is only a window dressing of the situation, whichnot many can afford.

Artemisinin compounds are a group of malaria medications that produce a very fast response in people with malaria, are active against multi drug resistant plasmodium falciparum, are well tolerated by people who have malaria and have the potential to reduce malaria transmission by decreasing parasite carriage in the blood stream. These include artesunate, artemether, dihydroartemisinin, usually used in combination with other antimalarial like mefloquine, amodiaquine, lumenfantrine, sulphadoxine/pyrimethamine, etc.

Right now, malaria control in Nigeria lies at the mercy of the above drugs and the provision of insecticide treated nets, and not much is given attention on the other way of show to tame the disease from within our environment. Because of the money involved, our leaders are blind in sticking to drugs and nets, thereby promoting the interest of their sponsors. This also make "………a number of large multilateral organizations" said Fatima U Bello to "have taken interest in themalaria eradication efforts and are now benefiting from more funding and more political interest" [Weekly Trust, April 26, 2008].

Even the insecticide treated nets that government gives emphasis on, the level of its acceptability and use is low among the people compare to the much publicity being given to the issue. According to the study of Aniefok Moses and Rakiya Madaki titled ‘Acceptance and use of Insecticide Treated Bed Net [ITN] in The Roll Back Malaria in Kuje Area Council, Federal Capital Territory [FCT]-Abuja’, published in The Journal of Environmental Health, March 2005, it shows that of the total population studied [348], 80.36% of the household do not have bed nets, and out of those who had net [85] only 28 [32.94% or 6.5% of the study population] were actually using the nets. More interestingly, those having the net but were not using it gave various reasons for non compliances; some claimed it is too hot, others are uncomfortable with it, disturb their breathing, and yet others find it very difficult using the net for various reasons. These and many more the study averred, are lack of accurate knowledge of ITN or its perceived ineffectiveness, poor massive social mobilization and community involvement, non awareness of the uses of ITN, etc.

The US president malaria initiative devotes $1.2 billion to malaria control in 15 Africa countries, the global funds for AIDS, TB andMalaria prevention and treatment, and many others, yet the emphasis of these grants is more on provision of drugs and nets than environmental management, which our relevant authorities are adhering to hook, line and sinker. More recently, the $100 million malaria fund [given by world bank] set for the eradication of malaria became a subject of debate as some states like programme managers of Bauchi and Anambra are claiming the programme is not given a priority in their states, and the fund are diverted to other uses by governors [Daily Trust July 22, 2009], hence they can not access it.

Even at the first ever 'World Malaria Day' [last year], and the recent one, not much was achieved, as all the emphasis is on provision of ACT, and distribution of ITN with little or no consideration at the prevention. And the leaders that ought to be proactive in making progress toward the control of the malaria are indifferent to do something tangible, even from the perspective of drugs and nets, which international organizations are more interested, for the nets are either hoard or diverted to other ways, hence not reaching the end users.

Malaria is an environmentally based disease, nevertheless, giving emphasis on its curative side [only] will leads us to no where, for our failure to clean and protect our environment, contributes a lot in the prevalence and endemic of malaria.

"Poor environmental sanitation" said Fidel "is characterized by abandonment of our sanitary responsibility as individuals and communities, increased urban slum, overstretched sanitary facilities, generation of huge solid and liquid waste…….." [Leadership March 2, 2008]. That is why it is common to find blocked highway and drainage, offensive odour etc in our environment.

Most importantly, this issue of environmental health rest in our local governments by virtue of 1999 constitution, but it is neglected and downplayed in favour of less equally challenging health problems. The situation is more appalling if one look at the relevant protocols recommended by World Health organization [WHO] to attain desired level of environmental health and sanitation.

For instance, one of the recommendations is that there should be one Environmental Health Officer [EHO] per 8000 people, but as at Nigeria of today, it falls short of this ratio. Now Nigeria needs minimum of 17500 EHO, but the number of those registered with Environmental health Officers Registration Council of Nigeria [EHORCN] is a little above 5000. More alarming according to Fidel, "research shows that some states do not have a single EHO in their local government".

We should know that malaria control rely on our hands, not on external support [though appreciative and welcome]. "We should be conscious" said Abubakar Azam "of all apparent strategies and learn t deal with them because it is foolhardy to assume the empathy of the 'giants' towards us. If they have such a feeling, it would have been cheaper for them to guide us to better manage our untapped resources and break the sequence of disease by ensuring the safety of our environment, provision of potable drinking water and better food production", [Weekly Trust, May 27, 2006].

Perhaps, it is because of this failure that Azam added "Any African countries that attempts to take care of these factors, sooner or later meet the wrath of the 'giants' for encouraging self-sufficiency, which is contrary to their design for Africa and Africans".

Many researchers argue that prevention of malaria may be more cost-effective than treatment of the disease in the long run; as such we must take our destiny in our hand by doing what suits our peculiarities, instead of adopting what others are dictating to us. Our leaders should increase much spending in malaria prevention and control, than diseases like HIV/AIDS which according to the editorial of Daily Trust 28th April, 2007 "…..gives its victims some kind of 'suspended life sentence', whereas malaria kills instantly. Even at the recent one-day sensitization workshop on malaria control and environmental sanitation organized for Non-Governmental Organizations by the Jigawa state People Congress, it was concluded by the Director environmental health and sanitation services of the ministry of environment, Dutse, Alhaji Haruna Usman Suleiman that ‘environmental sanitation’ is the back bone of malaria control, as such there is the need for rigorous support, willingness, commitment and dedication, coordination, collaboration and effectiveness in all aspects of environmental health [Daily Triumph July 14, 2009].

Also, the respondents [92.38%] of the study earlier cited above, agreed that the need for clean environment, because as far as vector population remains high due to our environmental management, the problem will persist even if ITN could be provided for every Nigerian.

Environmental health practitioners should be engaged in the policy and formulation of malaria control programme, whose contribution is indispensable if we must achieve desired goals, for their absence is making the programme one sided and ill-defined.

Lastly, the successful implementation of malaria control strategy requires sustained political commitment from all levels and sectors of government, integrating malaria control as part of health system, partnership with the communities, mobilization of adequate human and financial resources, and integrating those that deserve to gives the necessary leadership and commitment in making sure the programme succeed. This is the hard way and the only way.

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I am an environmental public health practitioner; obtained B. Tech Public Health, from Federal University of Technology, Owerri 2011-2014; obtained National/Higher National Diploma [HND] in Environmental Health Technology from School of Hygiene, Kano 1997-2001.